Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth

Wissow, Lawrence S.; Platt, Rheanna; Sarvet, Barry

doi:10.1016/j.acap.2020.08.014

Cited by 14 publications

(12 citation statements)

References 56 publications

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“…Increasing substantially the racial, ethnic, cultural, and linguistic diversity of the behavioral health care workforce. Recent recommendations are worthy of immediate action ( 47 , 51 , 62 ). Examples of federal action include: support of tuition waiver programs to encourage young people of color to enter the behavioral health workforce ( 51 ).…”

Section: Expand a Culturally Responsive Behavioral Health Workforcementioning

confidence: 99%

“…Allowing billing for the services of community health workers or navigators who can link families to behavioral health care and reinforce treatment recommendations through state level policy change, such as Medicaid reimbursement ( 45 , 62 ).…”

Section: Expand a Culturally Responsive Behavioral Health Workforcementioning

confidence: 99%

“…Policies must support their ability to effectively integrate behavioral health services, collaborate with a consultative psychiatric provider and/or team and engage in family-focused care. Recent policy recommendations by Wissow et al to promote integrated behavioral health care with a singular focus on the unique needs of children, adolescents and families are immediately impactful and relevant to address systemic needs wrought by the COVID-19 pandemic ( 62 ). At the state level, enact policies that allow for billing for behavioral health care on the same day as a primary care service, expanded billing codes that support collaborative work so that primary care and psychiatric providers can be paid for indirect consultation, case review, and referral coordination, and first-line behavioral health treatment by co-located or collaborating behavioral health providers of all disciplines as part of medical benefits (without additional co-pays).…”

Section: Expand a Culturally Responsive Behavioral Health Workforcementioning

confidence: 99%

“…Increasing substantially the racial, ethnic, cultural, and linguistic diversity of the behavioral health care workforce. Recent recommendations are worthy of immediate action (47,51,62).…”

Section: Ccbhcs Receive Flexible Funding To Improve Available Behavio...mentioning

confidence: 99%

See 3 more Smart Citations

Mitigating the Impact of Coronavirus Disease-2019 on Child and Family Behavioral Health: Suggested Policy Approaches

Long

Coates

Price

et al. 2022

The Journal of Pediatrics

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Section: Expand a Culturally Responsive Behavioral Health Workforcementioning

confidence: 99%

Section: Expand a Culturally Responsive Behavioral Health Workforcementioning

confidence: 99%

Section: Expand a Culturally Responsive Behavioral Health Workforcementioning

confidence: 99%

“…Increasing substantially the racial, ethnic, cultural, and linguistic diversity of the behavioral health care workforce. Recent recommendations are worthy of immediate action (47,51,62).…”

Section: Ccbhcs Receive Flexible Funding To Improve Available Behavio...mentioning

confidence: 99%

See 2 more Smart Citations

Mitigating the Impact of Coronavirus Disease-2019 on Child and Family Behavioral Health: Suggested Policy Approaches

Long

Coates

Price

et al. 2022

The Journal of Pediatrics

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“…Internationally, the literature highlights four key problems in the provision of mental healthcare for young people in most high-income countries: [ 1 ] poor penetration rate of services for the youth in need and a high rate of untreated prevalence; [ 2 ] delay in first contact and eventual treatment; [ 3 ] unsuitability of treatment for the particular stage of illness; and [ 4 ] serious problems with transitions between child and adult psychiatry [ 14 ]. Strengthening the role of first-line healthcare services targeting youth mental (ill) health [ 15 , 16 ], as the Swedish FLMHCY policy aims to, is in fact part of a broader international approach that seeks to address this weakness.…”

Section: Introductionmentioning

confidence: 99%

Protecting, managing and bending boundaries: a biomedicalization perspective on Swedish youth clinics’ responses to mental (ill) health

Goicolea

Wiklund

Linander

et al. 2022

BMC Health Serv Res

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Background Sweden has provided around 300 youth clinics (YCs) to address the health needs of young people since the 1970s. During the last few years, and as part of an effort to strengthen mental healthcare for young people, YCs’ role in the provision of mental healthcare has been widely debated. With such debates as background, the aim of this study is to analyse Swedish YCs’ responses to the mental (ill) healthcare needs of young people, from the perspective of national level stakeholders. Methods We used thematic analysis of interviews with eight national level stakeholders in the field of youth mental health in Sweden. Building upon the concept of biomedicalization we examined the discourses on mental (ill) health, healthcare and youth that such responses reproduce. Results YCs engage in the three simultaneous, but at times contradictory, responses of protecting, managing and bending boundaries. Remaining true to their mission as a health-promotion service compels them to protect their boundaries and limit the type of mental health issues they address. However, the perceived malfunctioning of specialized services has led them to bend these boundaries to allow in more young people with severe mental health problems. Caught between protecting and bending boundaries, the response of managing boundaries to decide who should be allowed in and who should be sent elsewhere has emerged as a middle-way response. However, it is not free from conflicts. Conclusion Building upon the concept of biomedicalization, this study poses two questions. The first relates to whether it is possible to support young people and their health without reinforcing discourses that represent young people as collectively at risk, and if so how this can be done. The second relates to the provision of mental healthcare for young people, and the need to identify conditions for integrating diagnosis and treatment within YCs, without hindering their holistic and youth-centred approach.

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Comprehensiveness of State Insurance Laws and Perceived Access to Pediatric Mental Health Care

Foster,

Hoffmann,

Douglas

et al. 2024

JAMA Netw Open

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ImportanceMany US children and adolescents with mental and behavioral health (MBH) conditions do not access MBH services. One contributing factor is limited insurance coverage, which is influenced by state MBH insurance parity legislation.ObjectiveTo investigate the association of patient-level factors and the comprehensiveness of state MBH insurance legislation with perceived poor access to MBH care and perceived inadequate MBH insurance coverage for US children and adolescents.Design, Setting, and ParticipantsThis retrospective cross-sectional study was conducted using responses by caregivers of children and adolescents aged 6 to 17 years with MBH conditions in the National Survey of Children’s Health and State Mental Health Insurance Laws Dataset from 2016 to 2019. Data analyses were conducted from May 2022 to January 2024.ExposureMBH insurance legislation comprehensiveness defined by State Mental Health Insurance Laws Dataset (SMHILD) scores (range, 0-7).Main Outcomes and MeasuresPerceived poor access to MBH care and perceived inadequacy of MBH insurance were assessed. Multivariable regression models adjusted for individual-level characteristics.ResultsThere were 29 876 caregivers of children and adolescents with MBH conditions during the study period representing 14 292 300 youths nationally (7 816 727 aged 12-17 years [54.7%]; 8 455 171 male [59.2%]; 292 543 Asian [2.0%], 2 076 442 Black [14.5%], and 9 942 088 White [69.6%%]; 3 202 525 Hispanic [22.4%]). A total of 3193 caregivers representing 1 770 492 children and adolescents (12.4%) perceived poor access to MBH care, and 3517 caregivers representing 1 643 260 of 13 175 295 children and adolescents (12.5%) perceived inadequate MBH insurance coverage. In multivariable models, there were higher odds of perceived poor access to MBH care among caregivers of Black (adjusted odds ratio [aOR], 1.35; 95% CI, 1.04-1.75) and Asian (aOR, 1.69; 95% CI, 1.01-2.84) compared with White children and adolescents. As exposures to adverse childhood experiences (ACEs) increased, the odds of perceived poor access to MBH care increased (aORs ranged from 1.68; 95%, CI 1.32-2.13 for 1 ACE to 4.28; 95% CI, 3.17-5.77 for ≥4 ACEs compared with no ACEs). Compared with living in states with the least comprehensive MBH insurance legislation (SMHILD score, 0-2), living in states with the most comprehensive legislation (SMHILD score, 5-7) was associated with lower odds of perceived poor access to MBH care (aOR, 0.79; 95% CI, 0.63-0.99), while living in states with moderately comprehensive legislation (score, 4) was associated with higher odds of perceived inadequate MBH insurance coverage (aOR, 1.23; 95% CI, 1.01-1.49).Conclusions and RelevanceIn this study, living in states with the most comprehensive MBH insurance legislation was associated with lower odds of perceived poor access to MBH care among caregivers for children and adolescents with MBH conditions. This finding suggests that advocacy for comprehensive mental health parity legislation may promote improved child and adolescent access to MBH services.

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Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth

Cited by 14 publications

References 56 publications

Mitigating the Impact of Coronavirus Disease-2019 on Child and Family Behavioral Health: Suggested Policy Approaches

Mitigating the Impact of Coronavirus Disease-2019 on Child and Family Behavioral Health: Suggested Policy Approaches

Protecting, managing and bending boundaries: a biomedicalization perspective on Swedish youth clinics’ responses to mental (ill) health

Comprehensiveness of State Insurance Laws and Perceived Access to Pediatric Mental Health Care

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